Monday, February 14, 2005

The Last Call

The high points of a doctor's post-graduate training are so few in number they can generally be recalled in the same amount of time and with the same enthusiasm it takes to flush a toilet. There is one event, however, that stands like a sequoia in the vast forest of memories preserved within the young doctor's mind - the night of his last call. Every doctor remembers the final time he entered the healing palace as the resident on-call. He drifts about the halls that night like a specter under the fluorescent lights, exploring the wards he once haunted. Like most nights on-call though it is a time for survival, not reminiscence. The goal is to live through the night without losing one's temper, mind or car keys.

It was with true dread that I stared at the doors of the hospital all those years ago on the last day of my three years of servitude. The season was glorious spring, when flowering crabapple trees delighted the weary eye and a young doctor's thoughts turned to shouting a hearty sayonara to the apprenticeship and hightailing it to fellowship or private practice. My sights though were only on the imposing brick building rising before me, for when it came to lucky omens I had just been handed the Monkey's Paw. Some residents spend their final hours grooming little old ladies on the geriatric service. My last supper was to take place within a more ominous painting. I walked into the lobby and gazed at the portrait of the President hanging above a collection of flags, releasing a sigh as I trudged upstairs.

According to the schedule, my last night on call was to be at the Veteran's Hospital.

Those doctors who have trained at the VA hospital know what it means to roam the halls where any minute one expects to encounter a human head bouncing down the stairs or see flames shooting from the oxygen mask of a surreptitious smoker. I therefore swept all bad thoughts away, steeled myself and went about the business of the day which consisted mainly of tracking down the reasons why exactly the old soldiers were there in the first place. The afternoon chugged by without incident, although our medical student was nearly asphyxiated when he walked into a lounge hosting the weekly bingo-game-and-cigarette-exchange. The only casuality before sundown was a jug of urine. One of my patients had diligently carried it from home to the hospital but had forgotten to give the specimen to me.

"What did you do with your 24-hour urine sample?" I asked. I needed to know if it contained any abnormal protein, which could indicate the presence of multiple myeloma.

"I gave it to the lab technician. Thought that would be faster than trying to find you."

Like an Olympic skier leaning into the final turn, I slalomed down the stairs to the laboratory in an attempt to rescue the precious carafe, but to no avail. By the time I crashed through the doors it was already lost. I argued with the staff in an attempt to get them to find the cursed bottle but they just gave me a look like a police officer about to conduct a sobriety test. The hospital once again held illimitable dominion over all. I furled the flag and crawled back to the floor.

Evening fell, and I soon collapsed into the recesses of the beastly place. I lay fully dressed on my on-call cot, two beepers clipped to my belt, which made me look rather like a tot carrying a pair of six-shooters. Even the VA settles a bit at night and before long my eyes were dead to the world. Unfortunately at the same time the eyes of one grizzled trooper also decided to shutter permanently, and a nurse who noticed the apparent lack of respiration dialed the operator to send in the Marines - or in other words "call a code".

I had just reached that part of a dream when after several frustrating attempts, one has convinced oneself that he can soar off into space by flapping the arms. Suddenly a horrific wailing pierced the skull and cut short my maiden flight. My red beeper was shrieking, signaling a cardiac arrest somewhere in the hospital. The operator called out the location over the tiny speaker but the sound was so bad it seemed as if she was reading back an order from a drive-through restaurant. I sped down the hallway. When I arrived at the emergency no one was there but the nurse and the veteran playing the non-speaking role. I of course had to do all the work that night - intubating the patient, starting his I.V., giving him the juice - both liquid and electrical, until the Three Fates made their final decision. Hours later I staggered into the nurses' station and according to witnesses downed a two-week-old can of soda that had been left behind the copy machine.

The following morning after a brief search my medical student found me lying supine on the floor of the conference room, humming "Don't Sit Under the Apple Tree". He gently shook me awake and we waddled off to breakfast. The last I heard of him he was running a Botox clinic in Honolulu.

Thus ended my last night of call. As I was helped out to my car I swiveled for one last look at the object of my detention. The stony facade seemed to fix me in its gaze, as in The Fall of the House of Usher. It was almost twenty years before I laid eyes on it again, and as I drove by the barren landscape, I could swear the old relic winked at me. I smiled back and realized that like two old prize fighters sitting in a diner we could now laugh about the punches we threw back then. The forecast was once again balmy, for our scars no longer ached - we were at peace.

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